Mental health nursing roles

On this page are descriptions of some of the most common roles and work environments in mental health nursing.

Mental health nursing – Asian

Developing the Asian Mental Health workforce has recently been acknowledged as one of the leading challenges specified in Te Kokiri: the Mental Health and Addiction Action Plan 2006-2015 (Ministry of Health, 2006). More than 66 per cent of Asians reside in the greater Auckland area (Statistics New Zealand, 2006).

An ideal DHB Asian Mental Health Services should:

  • offer clinical and cultural consultation and liaison services to the mainstream clinicians who experience difficulties while working with Asian clients
  • work in partnership with keyworkers to provide brief interventions
  • deliver cultural training to mainstream workers including clinicians and interpreters.

Qualifications and experience: Registered nurse able to practise in mental health nursing. Masters degree in health-related area. More than five years of mental health experience working in New Zealand. General knowledge of at least one Asian culture and the skills and experience in applying this knowledge to clinical areas.

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Alcohol and other drug/addiction nursing

In New Zealand primary care is charged with providing health education, screening and brief interventions for people with mild to moderate substance use problems, particularly alcohol and nicotine. Due to a high proportion of youth and adults with moderate to severe substance use problems (addiction) also experiencing co-existing mental health problems, treatment services are positioned under the mental health and addiction treatment umbrella.

A typical treatment system incorporates peer support, outpatient, detoxification, day patient and residential treatment services across DHB and NGO settings with strong linkages to the primary care, justice, education and welfare sectors. Treatment includes a range of psychosocial interventions, assistance with withdrawal (detoxification) and opioid substitution treatment. Kaupapa Maori and dedicated Pacific Services offer assessment and interventions for their respective cultural groups.

While all nurses have a role in providing health education, screening and brief assessments and interventions, nurses who specialise in AOD/addictions nursing frequently work in specialist multi-disciplinary team settings. In outpatient settings nurses typically work as clinical case managers with a youth or adult tangata whaiora/client caseload.

Depending on the service setting, nursing activities incorporate a mix of clinical and psychosocial interventions including assessment and monitoring of health status and individual, family and group interventions. For example working in a community or residential detoxification setting, clinical skills are particularly important.  Individual counselling generally incorporates motivational and cognitive behavioural approaches and involving significant others and whanau and family wherever possible.

Qualifications and experience: New graduate nurses seeking to work in specialist AOD/addiction nursing roles complete the specialty entry to mental health and addiction programme as a first step. Nurses who are advanced practitioners in the specialty will have completed a postgraduate addiction and co-existing disorders related qualification and will have had a minimum of four to five years broad experience in the field. Nurses who wish to become nurse practitioners will need to meet Nursing Council requirements (including prescribing-related) for this role.

The required general competency is the ability to combine individualised psychosocial and clinically-focussed interventions to assist tangata whaiora clients with behavioural, health and lifestyle changes. Key personal attributes are the ability to work systemically, with flexibility and creativity. Due to the stigma associated with addiction, attitudes and beliefs as well as particular psychotherapeutic skills play an important role in the ability to engage individuals into treatment, and enhance their motivation for behavioural and lifestyle change.

Other important competencies include: physical health screening/assessment and monitoring, health promotion and education, competencies related to working with clients with co-existing mental health disorders (many whom have experienced trauma in their lives), risk assessment and management, medication management, motivational skills and cognitive behavioural approaches, working with familes, networks  and groups.

Many thanks to Dr D Deering for this update.

Helping pregnant women and mothers of young children deal with alcohol and drug problems is a challenging role that is taking Elly Richard's nursing and midwifery skills to another level.

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Associate director of nursing/professional nurse leader/advisor

Provides professional, strategic and operational leadership, including but not limited to providing professional nursing leadership, consultancy and advice.  This aligns with the strategic objectives of nursing and the mental health service, namely:

  • increasing the effectiveness of service delivery by leading and developing quality improvement projects
  • facilitating development and maintenance of frameworks for policy and education
  • facilitating nursing input into policy and service development decisions at an organisational and national level
  • provides advice and direction to the nursing workforce in the maintenance of professional and ethical standards of practice
  • leading and supporting ongoing workforce development and nursing career pathways structures.

Qualification and experience: Registered Nurse with a minimum of five years experience in mental health nursing. Demonstrated leadership experience at an advanced level. Post graduate qualifications in nursing or associated area with demonstrated clinical expertise with experience in leading service developments and evaluations.

The national directors of mental health nursing

The national directors of mental health nursing promote the development and maintenance of a highly skilled, well resourced and well regarded mental health nursing workforce, which is responsive to consumer needs and in touch with national and international trends.

The national directors of mental health nursing are a group of professional nurse leaders of mental health services from across the sector.

The strategic goals of the national directors of mental health nursing are to:

  • provide authoritative comment on mental health nursing issues to statutory bodies and other national organisations
  • form alliances with organisations and health services to highlight and work through mental health nursing issues
  • provide strategic consultation, support and networking for professional mental health nursing leaders across New Zealand
  • contribute to the promotion of mental health nursing nationally and regionally.

To achieve these goals the national directors of mental health nursing meet three times a year and invite representatives from various mental health and nursing organisations to consult and liaise with, such as:

  • The Mental Health Directorate
  • The Nursing Council of New Zealand
  • The Mental Health Commission
  • The Nurse Executives of New Zealand
  • The Ministry of Health
  • workforce development agencies, Te Ao Maramatanga, Te Pou, Matua Raki, Te Rau Matatini and the Werry Centre
  • other individuals and groups as indicated.

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Clinical nurse specialist

Provides mental health nursing leadership that is committed to the ongoing development of high quality nursing practice and the establishment of best practice initiatives and to facilitate continuity and consistency of nursing care within multi-disciplinary teams.

Qualification and experience: Must be a New Zealand Registered Nurse with a minimum of three years experience in the relevant speciality. Post graduate pathway essential.

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Consultation liaison psychiatry

Works in a general hospital environment, providing assessment and care planning for clients who may present with mental health and/or addiction issues. Arranges referral to community mental health or AOD services for follow-up after discharge.

Provides advice about care of people in emergency departments, intensive care units and the full range of medical/surgical services. May involve duly authorised officer role.

Qualifications and experience:
Essential: Registered nurse able to practise in mental health nursing.
Preferred: Postgraduate Certificate/Diploma in Mental Health and/or working towards a Masters degree; four years' postgraduate mental health nursing.

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Early intervention community mental health nurse

Works with young people who have experienced psychosis for the first time, to establish a supportive relationship and provide treatment, education, support and information to the young person and their family in order to maximise recovery from psychosis. Works in the community in close contact with any community agency working with youth and young adults, to promote the early detection and early treatment of psychosis.

Qualifications and experience: Registered nurse able to practise in mental health nursing. Strong interest in working with young people, their families and communities in a hopeful and recovery focused manner.

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Mental health nursing – forensic (community)

Provides nursing care to meet the needs of those people with a mental health illness, or a suspected mental health illness, who are referred from the criminal justice system and require specialised assessment and management.

Primarily forensic mental health nursing in the community refers to court and prison services, although some people who have been through forensic inpatient rehabilitation services may be directly managed in the community under forensic services. Nursing in this sector falls under three distinct roles, community mental health nurse, prison liaison nurse and court liaison nurse with a very strong consultation liaison aspect underpinning all three. Each role has its unique characteristics but share the nursing fundamentals of assessment, planning, coordination, delivery and evaluation of individual care.

Qualification and experience: Must be a New Zealand Registered Nurse - comprehensive or psychiatric trained with a current annual practicing certificate. Post-graduate education highly desirable with the ability to effectively share clinical knowledge. Must be accomplished in risk assessment and have the ability to work autonomously.

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Mental health nursing – forensic (inpatient)

Provides nursing care to meet the needs of those people with a mental health illness, or a suspected mental health illness, who are referred from the criminal justice system and or exhibit significant risk behaviour and are likely to offend and require specialised assessment and management within a medium secure inpatient environment. These inpatient settings provide acute and rehabilitation pathways.

Nursing in this environment is embedded in the multi-disciplinary approach and involves the assessment, planning, coordination, delivery and evaluation of individual care, while working under the framework of the Mental Health Act and the Criminal Procedure (Mentally Impaired Persons) Act.

Qualification and experience: Must be a New Zealand Registered Nurse - comprehensive or psychiatric trained with a current annual practicing certificate. Post-graduate education highly desirable with the ability to effectively share clinical knowledge.

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NGO nursing

Mental health nurses working in the NGO (non-government organisation) sector contribute in many ways to the community.

The day to day role can consist of everything from completing comprehensive assessments and individually tailored plans to delivering behavioural and cognitive strategies, social skills and education to both service users, family/whanau and significant others.

The mental health nurse in the community supports recovery by supporting tangata whaiora, whanau/family and others to choose and access services, advocacy, advice, building and strengthening mental health and physical well-being opportunities. Having an integrated and collaborative approach with other service providers and agencies is most important.

Qualification and experience: A New Zealand Registered Nurse, with or working towards post graduate papers.

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Mental health nursing – nurse educator

The purpose of the educator role is to initiate and facilitate mental health service educational requirements for all staff and to provide educational support for other healthcare providers. The educator will champion the integration of research and evidence based practice.

Key tasks/accountabilities include:

  • Initiates and facilitates organisational specific educational requirements for all clinical staff.
  • Initiates and facilitates service specific educational requirements.
  • Facilitates educational opportunities to meet individual staff needs within specialised areas.
  • Provides educational support for healthcare providers and healthcare consumers.

The role specifically includes leadership, research, evidence based practice, quality and risk management, self-management and contribution to organisational leadership.

Qualification and experience:  Must be a NZ Registered Nurse - comprehensive or psychiatric trained. Postgraduate education highly desirable with the ability to effectively share clinical knowledge. Has achieved or is working towards Level 4 of PDRP within one year of commencing the position. Excellent group facilitation skills and a history of a collaborative team approach. Has advanced communication techniques such as conflict resolution, diffusion and mediation skills. Innovative, flexible with positive and problem solving approaches in all situations. Has proven clinical credibility in specialty area. Is a critical consumer of research and embraces evidence based practice when carrying out any task/function. Knowledge of and demonstrates use of adult teaching and learning principles. Committed to recovery principles in clinical practice. Has excellent computer skills.

Many thanks to Colette Rafter, Otago District Health Board for her contribution to the update of this section.

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Nurse practitioner

Nurse practitioners are expert nurses who work within a specific area of practice incorporating advanced knowledge and skills, for example diagnostic assessments, medication management and prescribing. They work autonomously, collaborating with other health professionals as necessary. In the mental health and addiction area the current three (nationally) nurse practitioners in clinical practice work for a DHB, but span between primary and secondary services. Along with working for the provider arm services, mental health nurse practitioners could also work in independent practice or for a PHO in general practice as a primary mental health nurse practitioner; or they could work for an NGO or community organisation.

Qualifications and experience: Registration with the Nursing Council of New Zealand in the Registered Nurse scope of practice. A minimum of four years' of experience in a specific area of practice and gaining advanced skills relevant to this area, for example in the mental health area this may be a qualification in some type of talking therapy such as CBT or counselling, and having demonstrated ability with teaching as a health educator. Successful completion of a clinically focused Masters degree programme approved by the Nursing Council of New Zealand.

Read profiles of nurse practitioners Bernadette Forde-Paus, a nurse practitioner mental health (prescribing) and Jeff Symonds, regional mental health nurse consultant and nurse practitioner in adult mental health services.

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Pacific mental health nurse

Pacific mental health nurses have a close relationship with the Pacific community, providing culturally comprehensive, appropriate care and treatment service to the Pacific community. Nurses liaise with Pacific consumers, families, other caregivers and community agencies. They may also have a role in supervising and mentoring Pacific student nurses.

Pacific mental health nurses work alongside other community mental health teams and specialised teams like intensive care teams, early psychosis, dual disability, community assessment team and other community teams as well as working closely with the inpatient unit in caring for Pacific people. Mental health promotion and community health education is important, in particular acknowledging the Pacific's perception of mental illness. Research such as exploring Pacific meanings of mental illness and integrating Pacific concepts into research methodologies to find culturally appropriate methodology for researching Pacific people is important and Pacific mental health nurses may choose to make this part of their role.

Qualification and experience: A New Zealand Registered comprehensive nurse or psychiatric nurse with extensive knowledge and awareness of Pacific cultures. Commitment to multi-cultural practice and an awareness of Pacific interpretation of mental health. Have or working towards post graduate papers.

Read about Chris Seu, a mental health nurse working for the Faleola team, a specialised Pacific Islands community mental health service in south Auckland.

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Primary mental health liaison

The development of Primary Health Care Strategy (2001) provided an opportunity to develop primary mental health services as an integral part of PHOs. In 2003 the Ministry of Health funded primary health initiatives with the target population being those with mild-moderate mental illness, estimated to be 17 per cent of the population at any one time.

The primary mental health nursing role, is an advanced practice role which requires health screening, assessment, case management, education, referral to secondary mental health services, referral to community agencies, project management, health promotion, community and inter-professional education and brief intervention (solution focused, problem solving, psycho education, family therapy, CBT).

Qualifications and experience: Registered nurse with scope of practice mental health. An advanced practice role requires a post graduate qualification and significant experience in mental health service delivery.

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Nursing-Alcohol and Other Drug/Addiction
In New Zealand primary care is charged with providing health education, screening and brief interventions for people with mild to moderate substance use problems, particularly alcohol and nicotine. Due to a high proportion of youth and adults with moderate to severe substance use problems (addiction) also experiencing co-existing mental health problems treatment services are positioned under the mental health and addiction treatment umbrella. A typical treatment system incorporates peer support, outpatient, detoxification, day patient and residential treatment services across DHB and NGO settings with strong linkages to the Primary Care, Justice, Education and Welfare sectors. Treatment includes a range of psychosocial interventions, assistance with withdrawal (detoxification) and opioid substitution treatment. Kaupapa Maori and dedicated Pacific Services offer assessment and interventions for their respective cultural groups.
While all nurses have a role in providing health education, screening and brief assessments and interventions, nurses who specialise in AOD/addictions nursing frequently work in specialist multi-disciplinary team settings. In outpatient settings nurses typically work as clinical case managers with a youth or adult tangata whaiora/client caseload. Depending on the service setting nursing activities incorporate a mix of clinical and psychosocial interventions including assessment and monitoring of health status and individual, family and group interventions. For example working in a community or residential detoxification setting, clinical skills are particularly important.  Individual counselling generally incorporates motivational and cognitive behavioural approaches and involving significant others and whanau and family wherever possible.
Qualification and experience: New Graduate nurses seeking to work in specialist AOD/addiction nursing roles complete the specialty entry to mental health and addiction programme as a first step. Nurses who are advanced practitioners in the specialty will have completed a postgraduate addiction and co-existing disorders related qualification and will have had a minimum of four to five years broad experience in the field. Nurses who wish to become Nurse Practitioners will need to meet the Nursing Council the requirements (including prescribing related) for this role.
The required general competency is the ability to combine individualised psychosocial and clinically focussed interventions to assist tangata whaiora clients with behavioural, health and lifestyle changes. Key personal attributes are the ability to work systemically, flexibility and creativity. Due to the stigma associated with addiction, attitudes and beliefs as well as particular psychotherapeutic skills play an important role in the ability to engage individuals into treatment and enhance their motivation for behavioural and lifestyle change. Other important competencies include: physical health screening/assessment and monitoring, health promotion and education, competencies related to working with clients with co-existing mental health disorders, many who have experienced trauma in their lives, risk assessment and management, medication management, skills in motivational and cognitive behavioural approaches, working with familes, networks  and groups.
Many thanks to Dr D Deering for this update.